Benefit of navigated cleavage in suprahyoidal deep neck space abscesses

Introduction:

Retropharyngeal abscesses are one complication in deep neck space infections. Cleavage can be very challenging due to delicate structures at risk and narrow working space when trying to achieve atraumatic and cosmetically favorable results. Inflammatory altered surrounding tissue and hindered visualization might fake sufficient drainage.

Methods:

We report on a series of n = 5 cases from two German university medical centers.

Results:

Four female and one male patient (2.3 – 73 years of age) have underwent at least one non-navigated procedure prior to revision surgery of a retropharyngeal abscess (max. diameter: 23 – 44 mm in imaging). These were located in n = 4 cases between carotid sheath and visceral division of the middle layer of deep cervical fascia and in n = 1 case between visceral division of the middle layer of deep cervical fascia, carotid sheath, and deep layer of deep cervical fascia (Vieira F et al. 2008). Definite solution was brought about a transoral approach via MRI- or CT-based optically tracked navigation using SCOPIS Hybrid Navigation and BrainLAB Kolibri 2.0. None of the patients had to be admitted to ICU. Microbiological spectrum ranged from Streptococcus pyogenes, Streptococcus mitis/oralis, Mycobacterium tuberculosis, α-hemolytic streptococci as well as Staphylococcus aureus, Klebsiella pneumoniae, and Enterococcus spec.

Conclusions:

First-line usage of CT- or MRI-based navigated transoral cleavage-procedures might reduce necessity of revision surgery in retropharyngeal abscesses.

Publication History

Publication Date:
23 April 2019 (online)